Incentives and Alerts for Improving Performance in Washington State Information on treatment process measures (e.g. initiation, engagement, and continuity of care measures) can be useful to specialty substance abuse treatment programs for tracking their performance and targeting areas for quality improvement efforts. The Washington State Division of Behavioral Health and Recovery (DBHR) will collaborate to study the impacts of two interventions, financial incentives and a client-specific alert system, on program performance and client outcomes. Client-specific alerts will be an enhancement to the data systems that are already in place in the state. Focusing on outpatient, intensive outpatient, detoxification, and residential programs, the alerts will provide programs with information, on a weekly basis, regarding specific clients who may not be meeting recommended levels of services so programs will be able to follow up with these clients with the goal of improving their performance measures. The proposed design will randomize programs in Washington State into the following study groups: Group A (Control Group), Group B (Incentives Only Group), Group C (Alerts Only Group) Group D (Incentives and Alerts Group). The differential impacts of these two interventions on the quality of care for subpopulations that may experience health disparities (e.g., racial/ethnic minorities or rural populations) will also be examined. Finally, the influenceof client and treatment program characteristics on the impacts of incentives and alert systems will be explored. The specific aims are as follows: 1. Examine if offering incentives only or providing client-specific alerts only leads to improved program performance and client outcomes. 2. Examine if client-specific alerts in combination with incentives lead to additional improvement in program performance and client outcomes beyond that of incentives only or alerts only. 3. Explore if there are differential impacts of incentives only, alerts only, or incentives plus alert on program performance by subpopulations (e.g., racial/ethnic minorities and rural clients). 4. Evaluate if client and program level factors are associated with programs' ability to achieve and maintain good performance. PUBLIC HEALTH RELEVANCE: Treatment process measures can be useful tools in specialty substance abuse treatment programs for tracking their performance and targeting areas for quality improvement efforts. The influence of two interventions: financial incentives and client-specific alerts on program performance and client outcomes will be examined using one state's administrative data. If successful in improving performance, each of these approaches could be adopted in other states for quality improvement.